The domain’s common reasons a Part A skilled day is down-coded or denied on medical review (ADR), and the corrected pattern. The full catalog lives in Denial Patterns.
Risk
Why it fails
Corrected pattern
Swallowing not assessed
Meals logged without an aspiration/swallowing assessment.
Document the swallowing/aspiration assessment and precautions each meal-period. (ADR.)
Aspiration signs not acted on
Coughing/wet voice noted without action.
Hold intake, notify, obtain a swallow re-eval, and reinforce precautions.
Silent aspiration missed
Respiratory change/low-grade fever not linked to swallowing.
Screen for silent aspiration and escalate a swallow evaluation.
Section K unsupported
K0100/K0510 coded without the note.
Carry the swallowing assessment and diet in the note. (F641.)
